Baby not engaged

[gypsy79]

Hi,

My sister is 39 weeks pregnant and her baby isn't engaged yet. Her dr has said if it doesn't happen soon she will have to have a caeser. Is this common? When does bubs usually engage?

Thanks.

[BellyBelly]

Argh this drives me mad it really does.

Some babies in first time mothers can engage early.... and some engage during labour. I think if a baby is not engaged, it means it's not ready, or not in position yet.

I know plenty of first time mums who didn't have an engaged baby until labour. They had babies fine, even homebirths! I think she should ignore the scaremongering and let her baby have a chance, at least until 42 weeks which is classed the end of full term.

[SweetPea]

I have a friend who recently had her first baby and it wasn't engaged until 40 weeks and she had a four hour labour, second stage was just 3 contractions! I'd talk to my ob and say I want to wait as long as possible to try and let things take their course naturally.

[BellyBelly]

From netdoctor:

Question: My baby's head hasn't engaged - will I need a Caesarean?

I am 39 weeks pregnant and have been told that my baby's head is not yet engaged.

What are the possible reasons for this? It should have happened by now.

If my baby's head doesn't engage, could that mean a Caesarean section?

Answer

In the last few weeks of pregnancy the baby's head usually moves downwards into the mother's pelvis. When the widest part of the head has moved through the brim of the pelvis, the head is said to have engaged.

Sometimes the head doesn't engage until labour begins. In that case the first few contractions will usually push the baby's head down into the pelvis and it will become engaged.

Sometimes a baby's head fails to engage because the size or shape of the mother's pelvis makes it difficult for the head to fit into the pelvis. In these cases, the labour may prove difficult and a Caesarean section may be necessary.

But please don't assume this will necessarily happen to you. Many women have a perfectly normal labour and delivery, despite the fact that their baby's head didn't engage before labour.

Yours sincerely

The Medical Team

From Transitional Doula:

So Your Baby Hasn’t Engaged?

You’ve just come from your internal exam at around 36 weeks and your care provider has informed you that your
baby’s head hasn’t descended into your pelvis (engaged). The care provider seemed to think this was unusual given
that this is your first baby (and sometimes even if it is not your first baby!). What does this really mean, and what can
you expect based on this information?

Fetal Station/Engagement
Your baby’s descent is measured in centimeters relative to the narrowest internal
diameter of your pelvis. This is at the level of two bony protrusions, called the ischial
spines. When your baby’s head is above the ischial spines, the baby is said to be at a
negative station, or “not engaged.” For instance, a baby who is at –3 station is resting
about 3 centimeters above the spines. A baby is said to be “engaged” when his head is
resting at the same level as the spines; this is also called “0 station.” A baby who has
descended past the ischial spines is at a positive station, e.g. +2 is 2 centimeters below
the ischial spines.

Why is this Important?
It is commonly believed and often stated in obstetrical textbooks that the majority of first babies engage several weeks
before the onset of labor. The existing research contradicts this belief. In reviewing the literature it appears that
approximately 70-75% of babies are not engaged at the onset of labor. Much of this research focuses on whether the
rate of cesarean delivery is increased when the baby is not engaged. While some studies did show a slight increase in
cesarean deliveries when the baby was not engaged during active labor, the conclusions also demonstrate that the vast
majority of babies are still born vaginally even when the baby was not engaged. Overall, approximately 85-90% of
babies that were not engaged at the onset of active labor were born vaginally.

Relevant Research
The following references can be discussed with your care provider if he or she is concerned about your baby not being
engaged (abstracts are included on the following pages):

Diegmann EK, Chez RA, Danclair WG. “Station in early labor in nulliparous women at term.” J Nurse Midwifery. 1995 Jul-
Aug;40(4):382-5.

Takahashi K, Suzuki K. “Incidence and significance of the unengaged fetal head in nulliparas in early labor.” Int J Biol Res Pregnancy.
1982;3(1):8-9.

Murphy K, Shah L, Cohen WR. “Labor and delivery in nulliparous women who present with an unengaged fetal head.” J Perinatol.
1998 Mar-Apr;18(2):122-5.

Roshanfekr D, Blakemore KJ, Lee J, Hueppchen NA, Witter FR. “Station at onset of active labor in nulliparous patients and risk of
cesarean delivery.” Obstet Gynecol. 1999 Mar;93(3):329-31.


You should ask if your doctor or midwife has any other relevant research.

J Nurse Midwifery. 1995 Jul-Aug;40(4):382-5.
Station in early labor in nulliparous women at term.
Diegmann EK, Chez RA, Danclair WG.
Nurse Midwifery Educational Program SHRP/UMDNJ, Newark 07107-3001, USA.

Several authors of standard obstetric texts state that engagement occurs before the onset of labor in a majority of nulliparas at term, and failure of the
fetal head to engage in early labor is a greater indicator for operative birth. A pilot clinical descriptive study was done at University Hospital,
University of Medicine and Dentistry of New Jersey, in Newark to examine the birth outcomes of nulliparous women who arrived in early labor with
an unengaged vertex presentation at term. For the study, 146 births were reviewed, and data from 101 vertex deliveries that met the study's criteria
were compiled to test this hypothesis. The study results showed that in approximately 31% of the nulliparas, the fetal head was engaged. The
incidence of the unengaged vertex in early labor in nulliparous women who met the study's criteria was found to be 69%. This factor alone did not
predict birth outcome.


Int J Biol Res Pregnancy. 1982;3(1):8-9.
Incidence and significance of the unengaged fetal head in nulliparas in early labor.
Takahashi K, Suzuki K.

Our clinical experience contradicts the traditional view that in the great majority of nulliparas with cephalic presentation the fetal head is engaged 1-2
weeks prior to onset of labor. In 75.4% of the 175 cases fetal head was not engaged in early labor. No significant statistical difference between the
unengaged-head group and the engaged-head group was determined for incidence of vaginal delivery, cesarean section for cephalopelvic
disproportion, midforceps delivery, mean and low Apgar scores, and birth weight. Thus, absence of engagement is not always indicative of pelvic
contraction. Incidence of engagement may depend on the ethnic composition of the patient population.

J Perinatol. 1998 Mar-Apr;18(2):122-5.
Labor and delivery in nulliparous women who present with an unengaged fetal head.
Murphy K, Shah L, Cohen WR.
Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, New York, NY, USA.

OBJECTIVE: We assessed the relation of fetal station in early labor to subsequent patterns of dilation and descent and to the probability of cesarean
delivery. STUDY DESIGN: We evaluated 132 nulliparous women who were in spontaneous latent-phase labor with singleton, vertex-presenting, term
fetuses. For each participant, pertinent variables relating to labor characteristics and mode of delivery and newborn characteristics were recorded.
Labor curves were drawn and analyzed. RESULTS: Of the 132 participants, 29 (22%) presented with an engaged fetal head, and 103 (78%) presented
with an unengaged fetal head. In the unengaged group, 15 (11%) presented with a floating fetal head (-3 station or above), and 88 (67%) presented
with a dipping fetal head (-2 or -1 station). A floating head in latent-phase labor conferred a longer second stage (p = 0.02), a trend to more active-
phase labor disorders (p = 0.06), and a greater risk of cesarean delivery. Overall, 12 patients (9%) underwent primary cesarean section: 2 (6.9%) from
the engaged group, 6 (6.8%) from the dipping group, and 4 (27%) from the floating group (p = 0.042). CONCLUSION: Most nulliparous women in
this study presented in labor with an unengaged fetal head. Those with a floating fetal head demonstrated higher rates of cesarean section than those
with dipping or engaged heads in early labor. [Overall 90.3% delivered vaginally.]


Obstet Gynecol. 1999 Mar;93(3):329-31.
Station at onset of active labor in nulliparous patients and risk of cesarean delivery.
Roshanfekr D, Blakemore KJ, Lee J, Hueppchen NA, Witter FR.
Department of Gynecology & Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

OBJECTIVE: To determine whether term nulliparas with an unengaged vertex presentation at onset of active labor have a higher risk for cesarean
delivery.

METHODS: A retrospective cohort of 1250 randomly chosen nulliparous patients at 37-42 weeks' gestation who delivered between 1988 and
1989 were selected. Four hundred forty-seven patients were excluded because of nonvertex presentation, cesarean delivery before active phase of
labor, multiple gestation, delivery at less than 37 weeks' or greater than 42 weeks' gestation, induction of labor, or missing charts. For the purpose of
this study, active labor was defined as regular contractions with cervical dilatation of at least 3 cm. The station at onset of active labor was recorded.
Engagement was considered to be at station 0 or below. RESULTS: Of the 803 patients in the study group, 567 presented unengaged [70.6%] and 236
patients presented engaged [29.4%]. The cesarean rates differed significantly between the two groups: 14% of those unengaged compared with 5% of
those engaged (chi2 = 11.9, P < .001). After adjusting for confounding variables, engagement at the time of onset of active labor was associated with
lower risk of cesarean delivery (odds ratio .512, 95% confidence interval .285, .922).

CONCLUSION: Eighty-six percent [86%] of nulliparas with an
unengaged vertex at onset of active labor delivered vaginally. Engaged vertex at the onset of active labor was associated with a lower risk of cesarean
delivery.

[shell_120308]

I am 39 weeks 3 days, so not long to go for me, only 4 days to go. I have been saying today 6 days to go, haha I musn't be able to count haha

But my bub's head isn't engaged yet, we had our ob apt on Tuesday and we have our next apt on Tuesday (day before he is due) and he will see where he is at if engaged etc. I am anxious for him to come out because I am suffering from the worst shoulder, neck and back pain and it is driving me nuts..... Just want my spine back.... haha

Anyway, everyone tells me that bub can engage at the last minute, so who knows, it is up to him when he wants to come out. Just have to let nature takes it course.

[BellyBelly]

How did your birth go Shell? Did your bub engage?